Set for a glenoid implant

ABSTRACT

This set comprising:
         an anatomic articulating member, having a concave articulating surface intended to articulate with a complementary humeral implant and having an anatomic coupling feature,   a reversed articulating member, having a convex articulating surface intended to articulate with a complementary humeral implant and having a reversed coupling feature that is shaped differently from the anatomic coupling feature, and   an anchorage member intended to be anchored in a human glenoid, the anchorage member including a body which defines a proximodistal axis and has inner bore extending along the proximodistal axis, the body being provided within the inner bore with both an inner first feature that is designed to cooperate with the anatomic coupling feature when the anatomic coupling feature is introduced within the inner bore, so as to fixedly couple the anchorage member with the anatomic articulating member, and an inner second feature that is designed to cooperate with the reversed coupling feature when the reversed coupling feature is introduced within the inner bore, so as to fixedly couple the anchorage member with the reversed articulating member, the first feature and the second feature being distinct from each other.       

     The body is operable to be axially introduced into the glenoid before being coupled indifferently with one or the other of the anatomic and reversed articulating members.

The present invention relates to a set for a glenoid implant. Theinvention also relates to glenoid implants.

In a healthy human shoulder, the head of the humerus, which is generallyball-shaped, and the glenoid cavity of the scapula, articulate with eachother and form a ball-and-socket joint. Total shoulder arthroplasty is acommon treatment for shoulder pain resulting from arthritis or injuryand leads to replace the ball-and-socket joint by a shoulder orthopedicprosthesis comprising both a glenoid implant to be implanted on theglenoid of the scapula and a humeral implant to be implanted on thehumerus. A shoulder prosthesis is considered as being anatomic when theglenoid implant has a concave articulating surface with which acomplementary convex surface of the humeral implant articulates. Ashoulder prosthesis is considered as being reversed when the glenoidimplant has a convex articulating surface with which a complementaryconcave surface of the humeral implant articulates, the natural anatomyof the ball-and-socket joint of the shoulder thus being reversed.

For some patients, the anatomic shoulder prosthesis is often used inprimary replacement and the reversed shoulder prosthesis can then beused when a revision is necessary. For other patients, the reversedshoulder prosthesis is directly implanted. Choosing the anatomic or thereversed shoulder prosthesis is made by the surgeon, if appropriateduring surgery, and depends on various factors including, amongstothers, quantity and quality of the bone tissue of the glenoid of thepatient's scapula. There is needed, therefore, a set of glenoid implantsallowing to implant indifferently an anatomic shoulder prosthesis and areversed shoulder prosthesis or even to convert an anatomic shoulderprosthesis to a reversed shoulder prosthesis.

Besides, for some patients, the bone loss of their glenoid can be great.Adding a bone graft to the glenoid implant of the shoulder prosthesismay be necessary. For that reason, there is needed a glenoid implantwhich makes easier to selectively incorporate such a bone graft.

Furthermore, there is a constant need to strengthen the attachment ofthe glenoid implant to the glenoid of the scapula, but without leadingto dissociate an articulating part of the glenoid implant from anotherpart that is directly engaged with the glenoid.

One of the goals of the present invention is to overcome at least someof the afore-mentioned problems.

To this end, one object of the invention is a set for a glenoid implant,comprising:

an anatomic articulating member, having a concave articulating surfaceintended to articulate with a complementary humeral implant and havingan anatomic coupling feature,

a reversed articulating member, having a convex articulating surfaceintended to articulate with a complementary humeral implant and having areversed coupling feature that is shaped differently from the anatomiccoupling feature, and

an anchorage member intended to be anchored in a human glenoid, theanchorage member including a body which defines a proximodistal axis andhas an inner bore extending along the proximodistal axis, the body beingprovided within the inner bore with both an inner first feature that isdesigned to cooperate with the anatomic coupling feature when theanatomic coupling feature is introduced within the inner bore, so as tofixedly couple the anchorage member with the anatomic articulatingmember, and an inner second feature that is designed to cooperate withthe reversed coupling feature when the reversed coupling feature isintroduced within the inner bore, so as to fixedly couple the anchoragemember with the reversed articulating member, the first feature and thesecond feature being distinct from each other,

the body being operable to be axially introduced into the glenoid beforebeing coupled indifferently with one or the other of the anatomic andreversed articulating members.

The set according to the invention allows implanting a glenoid implantindifferently for an anatomic shoulder prosthesis and for a reversedshoulder prosthesis, by using easily and safely a same member foranchoring in the glenoid of a patient. This anchorage member can be leftin place in the glenoid when converting the glenoid implant from ananatomic configuration to a reversed configuration.

According to additional advantageous features of this set:

The first feature and the second feature are located at respective axiallevels of the body that are different from each other.

The anatomic coupling feature and the first feature cooperate with eachother by fitting along the proximodistal axis.

The anatomic coupling feature and the first feature are fitted togetherby snap fit along the proximodistal axis.

The first feature comprises a corrugated hole that is centered on theproximodistal axis, and the anatomic coupling feature comprises a pegthat is integral with an insert of the anatomic articulating member andthat is shaped to be axially received and to be wedged in the corrugatedhole.

The reversed coupling feature and the second feature cooperate with eachother by a screw connection.

The second feature comprises a threaded hole that is centered on theproximodistal axis, and the reversed coupling feature comprises acoupling screw including a head that is axially engaged with a baseplateof the reversed articulating member and a rod that is threaded to bescrewed into the threaded hole.

The anatomic articulated member comprises an insert having a proximalface, on which is formed the concave articulating surface, and a distalface, from which at least a part of the anatomical coupling featureprotrudes.

The reversed articulating member comprises a glenosphere, on which isformed the convex articulating surface, and a baseplate having aproximal face, on which the glenosphere is fixedly mounted, and a distalface from which at least a part of the reversed coupling featureprotrudes.

The glenosphere is fixedly mounted on the baseplate by a taperconnection that is centered on the proximodistal axis.

The glenosphere defines a central axis which is both parallel to theproximodistal axis and offset from the proximodistal axis when thereversed articulating member is coupled with the anchorage member.

The set further comprises:

-   -   a spacer which is operable to be axially interposed between the        body and one or the other of the anatomic articulating member        and the reversed articulating member when the anchorage member        is coupled indifferently with one or the other of the anatomic        and reversed articulating members, and    -   a bone graft which is conformed to surround the spacer and to be        arranged axially between the glenoid and one or the other of the        anatomic articulating member and the reversed articulating        member.

The body is provided with an outer thread which is designed, when thebody is driven in rotation around the proximodistal axis so as to beintroduced into the glenoid, to pass through a subchondral bone layer ofthe glenoid by entirely passing from above to below the subchondral bonelayer so that a proximal end of the thread engages an underside of thesubchondral bone layer and the rest of the thread enters spongious boneof the glenoid.

The body is provided with an outer thread which is designed, when thebody is driven in rotation around the proximodistal axis so as to beintroduced into the glenoid, to pass through a subchondral bone layer ofthe glenoid, the outer thread including at least one portion of helixwhich has a lead between twelve and eighteen millimeters and wrapsaround the body over less than one turn and more than half of one turn.

The set further comprises a bone fastening screw intended to be screwedinto cortical bone of the glenoid, the bone fastening screw beingoperable to be axially passed through the body so that a threaded rod ofthe bone fastening screw protrudes axially from the body so as to bescrewed into cortical bone of the glenoid while a threaded head of thebone fastening screw is screwed in a complementary threaded distal holeof the body.

Another object of the invention is a first glenoid implant, comprising:

-   -   an articulating member intended to articulate with a humeral        implant;    -   an anchorage member intended to be anchored in a human glenoid,        the anchorage member including a body which defines a        proximodistal axis and which is operable to be axially        introduced into the glenoid before being fixedly coupled with        the articulating member;    -   a spacer which is operable to be axially interposed between the        body and the articulating member when the body and the        articulating member are coupled to each other; and    -   a bone graft which is conformed to surround the spacer and to be        arranged axially between the glenoid and the articulating        member.

Thanks to the spacer of this glenoid implant, a bone graft can be easilyincorporated in the glenoid implant and the articulating member may belateralized with respect to the scapula, which has functional interestsespecially for a reversed shoulder prosthesis.

According to additional advantageous features of this first glenoidimplant:

-   -   The spacer extends as a coaxial extension of the body.    -   The spacer is removably attached to the body.    -   The spacer is clipped on a proximal part of the body.    -   The spacer is integral with the body.    -   The articulating member has a coupling feature, the body is        provided with an inner feature that is designed to cooperate        with the coupling feature to fixedly couple the anchorage member        with the articulating member, and the spacer is axially hollow        so that the coupling feature freely passes through the spacer to        cooperate with the inner feature.    -   The articulating member is a reversed articulating member having        a convex articulating surface intended to articulate with a        complementary articulating surface of the humeral implant.    -   The reversed articulating member comprises a glenosphere, on        which is formed the convex articulating surface, and a baseplate        on which is fixedly mounted the glenosphere, the bone graft        being arranged axially between the glenoid and the baseplate.    -   The reversed articulating member further comprises a coupling        screw for fixedly coupling the baseplate with the body, the        coupling screw including:        -   a head that is axially engaged with the baseplate, and        -   a rod that is threaded to be screwed into a threaded hole of            the body after being freely passed through the spacer.    -   The bone graft is selected from the group consisting of        autologous graft, allograft and synthetic graft.

Another object of the invention is a second glenoid implant, comprising:

-   -   an articulating member intended to articulate with a humeral        implant, and    -   an anchorage member intended to be anchored in a human glenoid,        the anchorage member including a body which defines a        proximodistal axis and which is operable to be axially        introduced into the glenoid before being fixedly coupled with        the articulating member,

the body being provided with an outer thread which is designed, when thebody is driven in rotation around the proximodistal axis so as to beintroduced into the glenoid, to pass through a subchondral bone layer ofthe glenoid by entirely passing from above to below the subchondral bonelayer so that a proximal end of the thread engages underside of thesubchondral bone layer and the rest of the thread enters spongious boneof the glenoid.

In some embodiments, the thread includes at least one portion of helix,which has a proximal end forming the proximal end of the thread andwhich is designed to entirely pass through the subchondral bone layervia a longitudinal slot of the subchondral bone layer when the body isdriven in rotation around the proximodistal axis so as to be introducedinto the glenoid. In some embodiments, the at least one portion of helixhas a lead between twelve and eighteen millimeters and wraps around thebody over less than one turn and more than half of one turn.

Another object is a third glenoid implant, comprising:

-   -   an articulating member intended to articulate with a humeral        implant, and    -   an anchorage member intended to be anchored in a human glenoid,        the anchorage member including a body which defines a        proximodistal axis and which is operable to be axially        introduced into the glenoid before being fixedly coupled with        the articulating member,

the body is provided with an outer thread which is designed, when thebody is driven in rotation around the proximodistal axis so as to beintroduced into the glenoid, to pass through a subchondral bone layer ofthe glenoid, the outer thread including at least one portion of helixwhich has a lead between twelve and eighteen millimeters and wrapsaround the body over less than one turn and more than half of one turn.

Thanks to the thread of the second and third glenoid implants, theanchorage member can be screwed into the glenoid so as to place thethread just below the subchondral bone layer of the glenoid. In thatway, the subchondral part of the glenoid securely retains the anchoragemember into the glenoid, especially without adding cement, and thearticulating member of the glenoid implant can be in direct contacteither with topside of the subchondral bone layer or with a bone graftcovering the subchondral bone layer, so that in use, the stress on thearticulating member is essentially applied directly to the subchondralbone layer or to the aforesaid bone graft, instead of being essentiallyapplied to the anchorage member, in order to prevent the release ordissociation thereof with respect to the articulating member.

According to additional advantageous features of the second and thirdglenoid implants:

-   -   The at least one portion of helix has a width which gradually        decreases from its proximal end to its distal end.    -   Two portions of helix are provided, which are symmetrical with        respect to the proximodistal axis.    -   The articulating member has a coupling feature, the body is        provided with an inner feature that is designed to cooperate        with the coupling feature to fixedly couple the anchorage member        with the articulating member so that the articulating member is        in direct contact either with topside of the subchondral bone        layer or with a bone graft covering the subchondral bone layer.    -   The articulating member is an anatomical articulating member        having a concave articulating surface intended to articulate        with a complementary articulating surface of the humeral        implant.    -   The articulating member is a reversed articulating member having        a convex articulating surface intended to articulate with a        complementary articulating surface of the humeral implant.    -   The reversed articulating member comprises a glenosphere, on        which is formed the convex articulating surface, and a baseplate        on which is fixedly mounted the glenosphere, the bone graft        being arranged axially between the glenoid and the baseplate.    -   The glenosphere is fixedly mounted on the baseplate by a taper        connection that is centered on the proximodistal axis.    -   A part of the taper connection is integral with the body.    -   The glenosphere defines a central axis which is both parallel to        the proximodistal axis and offset from the proximodistal axis        when the reversed articulating member is coupled with the        anchorage member.    -   The body is made of a bioresorbable material.    -   The anchorage member is patient specific.    -   The glenoid implant further comprises a bone fastening screw        intended to be screwed into cortical bone of the glenoid, the        bone fastening screw being operable to be axially passed through        the body so that a threaded rod of the bone fastening screw        protrudes axially from the body to be screwed into cortical bone        of the glenoid while a threaded head of the bone fastening screw        is screwed in a complementary threaded distal hole of the body.

Embodiments of the invention will be better understood from reading thedescription which will follow, which is given solely by way of exampleand with reference to the drawings in which:

FIG. 1 is a cross-sectional view of a set for a glenoid implant;

FIG. 2 is a perspective view of an anchorage member of the set of FIG.1;

FIG. 3 is a view similar to FIG. 2, having a different angle ofobservation;

FIG. 4 is an elevational view along the arrow IV of FIG. 2;

FIG. 5 is an elevational view along the arrow V of FIG. 4;

FIG. 6 is a cross-sectional view along the line VI-VI of FIG. 5;

FIG. 7 is a side view of a bone fastening screw of the set of FIG. 1;

FIG. 8 is a perspective view of a spacer of the set of FIG. 1;

FIG. 9 is a view similar to FIG. 8, having a different angle ofobservation;

FIG. 10 is an elevational view along the arrow X of FIG. 8;

FIG. 11 is an elevational view along the arrow XI of FIG. 10;

FIG. 12 is a cross-sectional view along the line XII-XII of FIG. 11;

FIG. 13 is a perspective view of an insert of the set of FIG. 1;

FIG. 14 is an elevational view along the arrow XIV of FIG. 13;

FIG. 15 is a cross-sectional view in the plane XV of FIG. 13;

FIGS. 16 to 18 are views which are respectively similar to the FIGS. 13to 15 and which illustrate another insert of the set of FIG. 1;

FIG. 19 is a perspective view of a coupling screw of the set of FIG. 1;

FIG. 20 is a perspective view of another coupling screw of the set ofFIG. 1;

FIG. 21 is a perspective view of a baseplate of the set of FIG. 1;

FIG. 22 is an elevational view along the arrow XXII of FIG. 21;

FIG. 23 is a cross-sectional view along the line XXIII-XXIII of FIG. 22;

FIGS. 24 to 26 are views which are respectively similar to FIGS. 21 to23 and which show another baseplate of the set of FIG. 1;

FIG. 27 is a perspective view of a glenosphere of the set of FIG. 1;

FIG. 28 is an elevational view along the arrow XXVIII of FIG. 27;

FIG. 29 is a cross-sectional view along the line XXIX-XXIX of FIG. 28;

FIG. 30 is an elevational view along the arrow XXX of FIG. 29;

FIGS. 31 to 33 are perspective views which respectively show threesuccessive steps for implanting the anchorage member of FIG. 2 into aglenoid of a human scapula;

FIGS. 34 and 35 are schematic cross-sectional views respectively in theplane XXXIV and in the plane XXXV of FIG. 33;

FIGS. 36 and 37 are schematic cross-sectional views showing respectivelytwo successive steps for completing the anchorage member as implanted inFIG. 33 in order to provide an anatomic glenoid implant, the plane ofFIG. 36 being similar to the one of FIG. 34 whereas the plane of FIG. 37is similar to the one of FIG. 35; and

FIGS. 38 to 42 are schematic cross-sectional views respectively showingfour successive steps for completing the anchorage member as implantedin FIG. 33 in order to provide a reversed glenoid implant, the plane ofthe FIGS. 38 to 42 being similar to the one of FIG. 35.

FIG. 1 shows a set 1 of prosthetic components from which a glenoidimplant can be obtained by assembling at least some of these components.In some embodiments as the one shown in FIG. 1, the set 1 comprises ananchorage member 10, a bone fastening screw 20, a spacer 30, a bonegraft 40, a first insert 50, a second insert 60, a first coupling screw70, a second coupling screw 80, a first baseplate 90, a second baseplate100, a first glenosphere 110 and a second glenosphere 120. One or theother of the inserts 50 and 60 corresponds to an anatomic articulatingmember (AAM) for a glenoid implant obtained from the set 1. Each of thecombinations of one or the other of the glenospheres 110 and 120, withone or the other of the baseplates 90 and 100 and with one or the otherof the coupling screws 70 and 80 corresponds to a reversed articulatingmember (RAM) for a glenoid implant obtained from the set 1.

In some embodiments, each of the components 10, 20, 30, 40, 50, 60, 70,80, 90, 100, 110 and 120 or at least one of these components is providedwithin the set 1 in at least two different sizes which are respectivelyadapted to different patient morphologies. In some embodiments, each ofthe components 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110 and 120 orat least one of these components is patient-specific in the sense thatthe component in question includes certain geometric features which aremade to closely conform as mirror-images of corresponding geometricfeatures of a patient's anatomy which may be gathered during apreoperative planning stage based on tridimensional computer images ofthe corresponding anatomy.

Referring now to FIGS. 2 to 6, the anchorage member 10 is shown alone.The anchorage member 10 includes a body 11 which in use, is introducedinto the glenoid of a patient. The body 11 defines an axis Z11 on whichthe body 11 is centered and which is considered as extending in aproximodistal direction. In some embodiments as the one of the FIGS. 2to 6, the body 11 has a tubular shape that is centered on the axis Z11.The body 11 is thus provided with an inner bore 12 which axially extendsfrom a proximal end 11A of the body 11 to a distal end 11B of the body11, the inner bore 12 emerging on these proximal and distal ends 11A and11B.

At its proximal end 11A, the body 11 is provided with a driving feature13 for removably coupling the body 11 with a complementary tool so as todrive the body into the glenoid during implantation of the anchoragemember 10. The driving feature 13 can thus allow driving the body 11 inrotation around the axis Z11. In some embodiments as the one shown inthe FIGS. 2 to 6, the driving feature 13 includes indentations 13.1 and13.2 which are provided on the proximal end 11A of the body 11,especially on a free edge of this proximal end 11A, and which aredistributed around the axis Z11.

The body 11 has an outer face 14 extending from the proximal end 11A tothe distal end 11B. The outer face 14 can be cylindrical or slightlyfrustoconical and convergent towards the distal end 11B, while beingcentered on the axis Z11 in both cases.

On the outer face 14, the body 11 is provided with a thread 15 which isdesigned to be screwed into the glenoid when the body 11 is driven inrotation around the axis Z11, as explained in detail thereafter. In someembodiments as the one shown in the FIGS. 2 to 6, the thread 15 includestwo portions of helix 15.1 and 15.2 which wrap around the outer face 14of the body 11. The portions of helix 15.1 and 15.2 are symmetrical toeach other with respect to the axis Z11. As clearly shown in FIGS. 2 to4, each portion of helix 15.1, 15.2 wraps around the body 11 over lessthan one turn and more than half of one turn. Besides, each portion ofhelix 15.1, 15.2 has a lead between five and twenty-five millimeters,preferably between eight and twenty-two millimeters, preferably betweenten and twenty millimeters, and preferably between twelve and eighteenmillimeters, the lead being the distance along the axis Z11 that iscovered by one turn of the body 11, i.e. by rotating the body 11 over360°. The portions of helix 15.1, 15.2 are thus designed and dimensionedto entirely pass through a subchondral layer of the glenoid and to haverespective proximal ends 15.1A and 15.2A which are engaged withunderside of this subchondral bone layer at the end of implantation ofthe anchorage member 10. Moreover, in some embodiments as the one shownin the FIGS. 2 to 6, each of the portions of helix 15.1, 15.2 has awidth, i.e. a dimension radially protruding from the outer face 14 ofthe body 11, which gradually decreases from its proximal end 15.1A,15.2A to a distal end 15.1B, 15.2B of the portion of helix, as clearlyshown in FIGS. 4 and 5.

Within its inner bore 12, the body 11 is provided both with a firstfeature 16, that is observable in FIG. 2, and with a second feature 17that is observable in FIG. 3, the first feature 16 and the secondfeature 17 being distinct from each other as clearly shown in FIG. 6.The first feature 16 is designed to cooperate with the aforesaidanatomic articulating member AAM so as to fixedly couple the body 11with the anatomic articulating member AAM when the anchorage member 10is assembled with this anatomic articulating member. The second feature17 is designed to cooperate with the aforesaid reversed articulatingmember RAM so as to couple the body 11 with this reversed articulatingmember RAM when the anchorage member 10 is assembled with this reversedarticulating member. Thus, the first feature 16 and the second feature17 do not have the same function. From a structural point of view, theydiffer from each other in shape.

In some embodiments as the one shown in the FIGS. 2 to 6, in addition tobe shaped differently from each other, the first feature 16 and thesecond feature 17 are located at respective axial levels of the body 11,the axial levels being different from each other: as clearly shown inFIG. 6, the first feature 16 and the second feature 17 are disposedalong a length of the axis Z11. In some embodiments as the one shown inthe FIGS. 2 to 6, the first feature 16 being axially closer to theproximal end 11A of the body 11 whereas the second feature is axiallycloser to the distal end 11B of the body 11. In some other embodiments,the respective levels of the first feature 16 and of the second feature17 are reversed, the first feature being thus axially closer to thedistal end 11B of the body 11.

In some embodiments as the one shown in the FIGS. 2 to 6, the firstfeature 16 comprises, or even consists of, a corrugated hole 16.1, thatis centered on the axis Z11 and that forms a proximal part of the innerbore 12, and the second feature 17 comprises, or even consists of, athreaded hole 17.1, that is centered on the axis Z11 and that forms adistal part of the inner bore 12. The technical interest of these twoshapes for the features 16 and 17 will appear thereafter.

In some embodiments as the one shown in the FIGS. 2 to 6, the body 11 isalso provided with an attaching feature 18 which is designed tocooperate with the spacer 30 so as to removably attach the body 11 andthe spacer 30 together when the body is assembled to the spacer. Thisattaching feature 18 is arranged at a proximal part of the body 11. Insome embodiments as the one shown in the figures, the attaching feature18 is thus located within a proximal part of the inner bore 12,especially axially between the first feature 16 and the edge forming theproximal end 11A of the body 11. In other (not shown) embodiments, theattaching feature is not located within the inner bore 12 but isprovided at the edge forming the proximal end 11A of the body 11 and/orat a proximal part of the outer face 14 of the body 11.

In some embodiments as the one shown in the FIGS. 2 to 6, the attachingfeature 18 comprises recessed notches 18.1 and 18.2, which aredistributed around the axis Z11. As shown by FIG. 6, each of the notches18.1 and 18.2 has a bottom that is closed in the proximal direction soas to axially retain the spacer 30 in the proximal direction withrespect to the body 11 when the anchorage member 10 and the spacer 30are assembled together. In some (not shown) embodiments, the attachingfeature 18 is partly or totally formed by the first feature 16 of theinner bore 12 of the body 11.

In some embodiments as the one shown in FIGS. 2 to 6, the body 11 isalso provided with a threaded hole 19 which is designed to cooperatewith the bone fastening screw 20 so that this bone fastening screw 20can be screwed in the threaded hole 19 when the anchorage member 10 andthe bone fastening screw 20 are assembled together. The threaded hole 19is arranged at a distal part of the body 11. The threaded hole opensoutside the body in the distal direction whereas the threaded hole 19opens in the inner bore 12 in the proximal direction. In someembodiments as the one shown in the FIGS. 2 to 6, the threaded hole 19is partially or totally formed by the second feature 17 of the innerbore 12. In other (not shown) embodiments, the threaded hole 19 is inthe distal extension of the inner bore 12, being centered or not on theaxis Z11. In some embodiments, the body 11 is either made of metallicalloy or made of bioresorbable material.

Referring now to FIG. 7, the bone fastening screw 20 is shown alone.This screw defines a longitudinal axis Z20, on which the screw iscentered and which extends in the proximodistal direction. The screw 20includes a head 21 and a rod 22, which are each centered on the axis Z20and which follow each other in the direction of this axis. The head 21forms a proximal part of the screw 20 and is threaded complementarily tothe threaded hole 19 of the anchorage member 10. The rod 22 forms adistal part of the screw 20 and is also threaded. In some embodiments asthe one shown in FIG. 7, the rod 22 has a diameter which is smaller thanthe diameter of the head 21.

In use, the bone fastening screw 20 can be axially passed through thebody 11 of the anchorage member 10 so that the rod 22 protrudes axiallyfrom the body while the head 21 is screwed in the threaded hole 19 ofthe body 11. Thus, when the head 21 is arranged within the threaded hole19 of the body 11, the rod 22 is arranged outside of this body 11, beinglocated on the distal side of the body 11. In that way, the rod 22 canbe screwed into the glenoid of a patient, especially into cortical bone,so that the screw 20 fastens the anchorage member 10 to the glenoid,especially cortical bone thereof.

Referring now to FIGS. 8 to 12, the spacer 30 is shown alone. The spacer30 comprises a body 31 which defines an axis Z31 extending in theproximodistal direction. The body 31 has a tubular shape centered on theaxis Z31. The spacer 30 is thus provided with an inner bore 32, that iscentered on the axis Z31 and that extends from a proximal end 31A of thebody 31 to a distal end 31B of the body 31.

In use, the spacer 30 is designed to be arranged on the proximal side ofthe body 11 of the anchorage member 10 so that the inner bores 12 and 32are in axial extension or alignment one with the other, especiallyaligning the axis Z11 and Z31. In some embodiments, the body 31 canextend as a coaxial extension of the body 11 in the direction of theaxis Z11. In any case, the spacer 30 can, in use, be axially interposedbetween the body 11 and either the aforesaid anatomic articulatingmember AAM when the anchorage member 10 and this anatomic articulatingmember are assembled together, or the aforesaid reversed articulatingmember RAM when the anchorage member 10 and this reversed articulatingmember are assembled together.

In some embodiments as the one shown in the FIGS. 8 to 12, the body 31is provided with an attaching feature 33 which is designed to cooperatewith the attaching feature 18 of the body 11 so as to removably attachthe bodies 11 and 31 when the anchorage member 10 and the spacer 30 areassembled together. The attaching feature 33 is arranged at a distal endof the body 31. In some embodiments as the one shown in the FIGS. 8 to12, the attaching feature 33 is provided at the edge forming the distalend 31B of the body 31 and comprises tabs 33.1 and 33.2, which aredistributed around the axis Z31 and which are flexibly connected to therest of the body 31: in use, when the anchorage member 10 and the spacer30 are assembled together, the tabs 33.1 and 33.2 are respectivelyreceived in the recessed notches 18.1 and 18.2, their introductionrequiring them to deform elastically towards the axis Z31 whereas oncethey are completely introduced in the recessed notches 18.1 and 18.2,the free end of each of the tabs 33.1 and 33.2 are resiliently biasedinto the bottom of the corresponding notch so as to axially retain thebody 31 with respect to the body 11. In other words, the tabs 33.1 and33.2 can be clipped onto the recessed notches 18.1 and 18.2. Of course,the tabs 33.1 and 33.2 and the recessed notches 18.1 and 18.2 are onlyan example for the attaching features 18 and 33, which allows a distalpart of the body 31 to be clipped on a proximal part of the body 11.More generally, the arrangement of the attaching feature 33 on the body31 and the shape of this attaching feature 33 are adapted to thearrangement of the attaching feature 18 on the body 11 and the shape ofthis attaching feature 18 so as to allow the spacer 30 to be added andattached to the anchorage member 10.

In some embodiments as the one shown in the FIGS. 8 to 12, the body 31is provided with a driving feature 34 for removably coupling the body 31with a complementary tool so as to drive the body 31 during implantationof the spacer 30. In practice, this driving feature 34 of the spacer 30can be functionally or even structurally similar to the driving feature13 of the body 11 of the anchorage member 10. In particular, similarlyto what has been described above for the driving feature 13, the drivingfeature 34 can include indentations 34.1 and 34.2 provided on the edgeforming the proximal end 31A of the body 31. Besides, whatever the typeof the driving feature 34 of the spacer 30, the body 31 can be designedto transmit drive movements to the anchorage member 10 when the latteris assembled with the spacer 30 during implantation of them. Such adrive transmission can be at least partly provided by the cooperationbetween the attaching feature 18 of the body 11 and the attachingfeature 33 of the body 31. In some embodiments as the one shown in theFIGS. 8 to 12, such a drive transmission can also be at least providedby a dedicated transmitting feature 35 which is designed to cooperatewith the driving feature 13 of the body 11 so as to transmit drivemovements from the spacer 30 to the anchorage member 10, especially totransmit rotational drive movements around the axes Z31 and Z11, whenthe anchorage member 10 and the spacer 30 are assembled together. Ofcourse, the arrangement of the transmitting feature 35 on the body 31and the shape of this transmitting feature 35 are adapted to thearrangement of the driving feature 13 on the body 11 and the shape ofthis driving feature 13: in the example of the FIGS. 8 to 12, thetransmitting feature 35 comprises projections 35.1 and 35.2, which areprovided on the edge forming the distal end 31B of the body 31 and whichare respectively received in the indentations 13.1 and 13.2 so as toconnect in rotation the bodies 11 and 31 together.

Referring back to FIG. 1, the bone graft 40 will be now described. Thebone graft 40 is annular shaped and is conformed to surround the body 31of the spacer 30. To this end, the bone graft 40 is provided with athrough hole 41, which is centered on an axis Z41 extending in theproximodistal direction and which is complementary to the body 31. Thethrough hole 41 axially extends from a proximal end face 40A of the bonegraft 40 to a distal end face 40B of the bone graft, these end faces 40Aand 40B being separated by the axial dimension of the bone graft 40,which substantially corresponds to the axial dimension of the spacer 30.

In use, the body 31 is received within the through hole 41, aligning theaxis Z31 with the axis Z41 so that the bone graft 40 extends all overthe spacer 30 around its axis Z41 and can be arranged axially betweenthe glenoid of the patients and either the aforesaid anatomicarticulating member AAM or the aforesaid reversed articulating memberRAM, as explained in detail thereafter. In other words, the spacer 30may be at least partially or entirely retained within the bone graft 40.

In some embodiments, the bone graft 40 is an autologous graft, anallograft or a synthetic graft.

Referring now to FIGS. 13 to 15, the first insert 50 is shown alone. Theinsert 50 defines a central axis Z50 that extends in the proximodistaldirection. The insert 50 has a proximal face 50A on which is formed aconcave articulating surface 51. In use, this concave articulatingsurface 51 is provided to articulate with a complementary convexarticulating surface 3 of a humeral implant 2 that is only partiallydrawn in FIG. 1, in dotted lines. The type of this humeral implant 2 isnot limitative as long as the articulating surface 3 thereof is convexand complementary to the concave articulating surface 51 of the insert50.

Furthermore, the insert 50 has a distal face 50B which is provided withan anatomic coupling feature 52. This coupling feature 52 is designed tocooperate with the first feature 17 of the anchorage member so as tofixedly couple the anchorage member 10 with the insert 50 and thereforewith the aforesaid anatomic articulating member AAM when this lattercorresponds to the first insert 50.

In some embodiments as the one shown in the FIGS. 13 to 15, the couplingfeature 52 of the insert 50 at least partly protrudes from the distalface 50B so as to be coaxially received within the inner bore 12 of theanchorage member 10 and to cooperate with the first feature 16 byfitting along the axis Z11 when the anchorage member 10 and the insert50 are assembled together. In that case and as shown by the FIGS. 13 to15, the coupling feature 52 can comprise a central peg 52.1, which iscentered on the axis Z50 and which is designed to be fitted with thefirst feature 16 within the inner bore 12 by snap fit: in particular,the central peg 52.1 is shaped to be axially received and to be wedgedin the corrugated hole 16.1 of the first feature 16 when the anchoragemember 10 and the insert 50 are assembled together. At its proximal end,this central peg 52.1 can be integral with the rest of the insert 50whereas the rest of the central peg 52.1 can be either smooth orprovided with at least one peripheral rib 52.2 designed to interferewith at least one of the corrugations of the corrugated hole 16.1.Moreover, the central peg 52.1 can be slotted, as in the example shownin the FIGS. 13 to 15, in order to facilitate the introduction of thecentral peg 52.1 within the inner bore 12 and to improve the axialfitting of this central peg with the first feature 16. More generally,the coupling feature 52 can have various types, being adapted to thetype of the first feature 16, preferably so that the coupling feature 52and the first feature 16 cooperate with each other by fitting along thealigned axes Z11 and Z50.

The distal face 50B of the insert 50 is also provided with two lateralpegs 53 which at least partly protrude from this distal face 50B. Theselateral pegs 53 are distributed around the axis X50 and are designed tointerfere with the glenoid of the patient so as to block the insert 50in rotation around the axis Z50 with respect to the glenoid.

In some embodiments as the one shown in the FIGS. 13 to 15, the lateralpegs are arranged either side of the central peg 52.1, the central peg52.1 and the lateral pegs 53 being aligned in direction perpendicular tothe axis Z50. Besides, each lateral peg 53 is arranged to surround andcover an angular portion of the outer thread 15 of the body 11 when theanchorage member 10 and the insert 50 are assembled together. Inparticular, the radial distance between the central peg 52.1 and each ofthe lateral pegs 53 is substantially equal to the sum of wall thicknessof the body 11 and of the maximal width of the thread 15, and the faceof each of the lateral pegs 53, which radially faces the central peg52.1, is complementary to the outer contour of the thread 15: in thatway, two diametrical opposed portions of the wall of the body 11 areradially sandwiched respectively between the central peg 52.1 and one ofthe lateral pegs 53 and between the central peg 52.1 and the otherlateral peg 53 when the anchorage member 10 and the insert 50 areassembled together. This arrangement can strengthen the cooperationbetween the coupling feature 52 and the first feature 16 by pinchingeffect of the body 11 by the lateral pegs 53. At least one furthertechnical interest will be given thereafter.

In some embodiments, the distal face 50B of the insert 50 is at leastpartly provided with a coating permitting or promoting bone regrowth.

Referring now to the FIGS. 16 to 18, the second insert 60 is shownalone. As is apparent by comparison between the FIGS. 13 to 15 and theFIGS. 16 to 18, the insert 60 has a central axis Z60, a proximal face60A, a concave articulating surface 61, a distal face 60B, a couplingfeature 62, a central peg 62.1 and at least one peripheral rib 62.2,which are respectively similar to the elements Z50, 50A, 51, 50B, 52,52.1 and 52.2 of the insert 50. The insert 60 differs from the insert 50by lateral pegs 63. Contrary to the lateral pegs 53 of the insert 50,the lateral pegs 63 are in triplicate, being distributed around the axisZ60, and are spaced from the central peg 62.1 by a radial distance whichis greater than the sum of the wall thickness of the body 11 and of themaximal width of the thread 15. In use, the lateral pegs 53 do notinterfere with the thread 15 when the anchorage member 10 and the insert60 are assembled together, but they can still block the insert 60 inrotation around the axis Z60 with respect to the glenoid, by interferingdirectly with the glenoid.

Referring now to FIG. 19, the first coupling screw 70 is shown alone.This coupling screw 70 defines and is centered on an axis Z70 whichextends in the proximodistal direction. The coupling screw 70 includes aproximal head 71 and a distal rod 72. The rod 72 is designed to beaxially introduced into the inner bore 12 of the body 11, aligning theaxes Z70 and Z11, and to cooperate with the second feature 17 so as tofixedly couple the anchorage member 10 with the aforesaid reversedarticulating member RAM by a screw connection when this reversedarticulating member and the anchorage member are assembled together. Insome embodiments as the one shown here, this screw connection iscentered on the axis Z11.

In some embodiments as the one shown in FIG. 19, the rod 72 is providedwith a threaded part 72.1 which can be screwed into the threaded hole17.1 of the second feature 17, by rotating the coupling screw 70 aroundits axis Z70 within the inner bore 12. In some embodiments as the oneshown in FIG. 19, the head 71 is wider than the rod 72, in the sensethat the diameter of the head 71 is greater than the diameter of the rod72.

Referring now to FIG. 20, the second coupling screw 80 is shown alone.This coupling screw is similar to the first coupling screw 70 in thatthe coupling screw 80 has an axis Z80, a head 81, a rod 82 and athreaded part 82.1 which are respectively similar to the elements Z70,71, 72 and 72.1 of the coupling screw 70. The coupling screw 80 differsfrom the coupling screw 70 by its length, i.e. its axial dimension: therod 82 is axially longer than the rod 72, as clearly shown by comparingthe FIGS. 19 and 20. The first coupling screw 70 is used in theaforesaid reversed articulating member RAM when the latter is assembledwith the anchorage member 10 without that this anchorage member 10 isassembled with the spacer 30. The second coupling screw 80 is used inthe aforesaid reversed articulating member RAM when this latter isassembled with the anchorage member 10 with which the spacer 30 isassembled: in that case, as the spacer 30 is axially interposed betweenthe body 11 and the reversed articulating member, an axial part of therod 82 is necessarily arranged within the inner bore 32 of the spacer 30so as to allow the distal part of the rod 82, especially its threadedpart 82.1, to cooperate with the second feature 17, after having freelypassed in the distal direction through the spacer 30 via the inner bore32 thereof.

Turning now to the FIGS. 21 to 23, the first baseplate 90 is shownalone. The baseplate 90 comprises a body 91 defining a central axis Z91which extends in a proximodistal direction. The body 91 has a proximalface 91A and a distal face 91B. The body 91 is also provided with acentral bore 92, which is centered on the axis Z91 and which extendsfrom the proximal face 91A to the distal face 91B. The central bore 92is designed to coaxially receive indifferently the first coupling screw70 and the second coupling screw 80 depending on whether the firstcoupling screw 70 or the second coupling screw 80 is used in theaforesaid reversed articulating member RAM. The rod 72, 82 of thiscoupling screw 70, 80 can be freely received in the central bore 92whereas the head 71, 81 can be axially engaged within the central boreso as to axially retain the head in the distal direction while a distalpart of the rod 72, 82 protrudes from the distal face 91B of the body91. In some embodiments as the one shown in the FIGS. 21 to 23, thecentral bore is provided with an axial bearing surface 92.1 againstwhich the head 71, 81 can be supported in the distal direction.

In some embodiments as the one shown in the FIGS. 21 to 23, the proximalface 91A of the body 91 is provided with a male part 93 of a taperconnection intended to be used to fixedly mounted indifferently one andthe other of the glenospheres 110 and 120 on the baseplate 90. The malepart 93 of this taper connection can be centered on the axis Z91, a partof the central bore 92 being thus delimited by the male part 93 of thetaper connection, as clearly shown by FIG. 23.

In some embodiments as the one shown in the FIGS. 21 to 23, the body 91is also provided with lateral through holes 94 which each extends fromthe proximal face 91A to the distal face 91B of the body 91. Each ofthese lateral through holes 94 is designed to receive and engage in thedistal direction a bone securing screw, as explained in detailthereafter.

Referring now to the FIGS. 24 to 26, the second baseplate 100 is shownalone. As is apparent by comparing the FIGS. 21 to 23 with the FIGS. 24to 26, the second baseplate 100 has a body 101, a central axis Z101, aproximal face 101A, a distal face 101B, a central bore 102, an axialbearing surface 102.1, a male part 103 of a taper connection, andlateral through holes 104, which are respectively similar to theelements 91, Z91, 91A, 91B, 92, 92.1, 93 and 94 of the first baseplate90. The second baseplate 100 differs from the first baseplate 90 by itsdistal face 101B: as clearly shown by the FIGS. 22 and 23, the distalface 91B of the first baseplate is convex whereas the distal face 101Bof the second baseplate 100 is substantially planar, being perpendicularto the axis Z101. In use, the distal face 91B, 101B of the baseplates 90and 100 is intended to be in direct contact with bone tissue, moreprecisely either the glenoid of a patient or the bone graft 40 axiallyarranged between the glenoid and indifferently one and the other of thebaseplate 90 and 100: therefore, using one or the other of the baseplate90 and 100 depends on the shape of bone tissue that is to cover by thedistal face 91B, 101B of the baseplate, as discussed thereafter.

In some embodiments, the distal face 91B of the baseplate 90 and/or thedistal face 101B of the baseplate 100 are at least partly provided witha coating permitting or promoting bone regrowth

Referring now to the FIGS. 27 to 30, the first glenosphere 110 is shownalone. The glenosphere 110 comprises a body 111 which corresponds to aportion of a sphere. This body 111 defines a central axis Z111 whichextends in the proximodistal direction and on which is centered theaforesaid sphere portion. The body 111 has a proximal face 111A on whichis formed a convex articulating surface 112 that is substantiallyspherical. In use, the convex articulating surface 112 articulates witha concave complementary surface 5 of a humeral implant 4 that is onlypartially drawn in FIG. 1, in dotted lines. The type of this humeralimplant 4 is not limitative as long as the articulating surface 5thereof is convex and complementary to the concave articulating surface51 of the insert 50.

The body 111 further has a distal face 111B which is designed to befixedly mounted indifferently on one and the other of the first andsecond baseplates 90 and 100, especially by the aforesaid taperconnection. In some embodiments as the one shown in the FIGS. 27 to 30,the distal face 111B of the body 11 is provided with a female part 113of this taper connection and is therefore designed to receive and attachto the male part 93, 103 of the corresponding baseplate 90, 100. Thefemale part 113 of the taper connection is centered on a connection axisZ113 which is aligned with the axis Z91, Z100 of the correspondingbaseplate 90, 100 when the corresponding male part 93, 103 of the taperconnection cooperates with the female part 113.

As shown by the FIGS. 28 to 30, the central axis Z111 of the body 111 isboth parallel to the connection axis Z113 and offset from thisconnection axis Z113: when the glenosphere 110 is assembled withindifferently one and the other of the first and second baseplates 90and 100, the convex articulating surface 112 is eccentric with respectto the corresponding central axis Z91, Z101 of the correspondingbaseplate. Thus, the first glenosphere 110 can be considered as being aneccentric glenosphere for a corresponding glenoid implant obtained fromthe set 1.

Referring back to FIG. 1, the second glenosphere 120 will now bedescribed. This second glenosphere 120 is similar to the firstglenosphere 110, except that this second glenosphere 120 is noteccentric. In other words, as shown in FIG. 1, a female part 123 of theaforesaid connection, which is similar to the female part 113 of thefirst glenosphere 110, is centered on a central axis Z121 of theglenosphere 120, which is similar to the central axis Z111 for the firstglenoid 110.

Based on the foregoing, it will be understood that within the aforesaidreversed articulating member RAM, the first coupling screw 70 and thesecond coupling screw 80 correspond indifferently to a coupling featurethat is designed to cooperate with the second feature 17 of theanchorage member so as to couple the reversed articulating member RAMwith the anchorage member 10. This coupling feature of the reversedarticulating member RAM, which can be designated as a reversed couplingfeature, is shaped differently from the anatomic coupling feature 52, 62of the aforesaid anatomic articulating member AAM. Besides, thanks toits first feature 16 and its second feature 17, the body 11 of theanchorage member 10 is operable to be coupled indifferently with one orwith the other of the aforesaid anatomic and reversed articulatingmembers.

The technical aspect, that has just been mentioned, and other technicalaspects will now be illustrated in reference to the FIGS. 31 to 42 byexamples of using the set 1 in order to obtain two glenoid implants,i.e. an anatomic glenoid implant and a reversed glenoid implant.

FIG. 31 shows a human scapula S having a glenoid G. Before using the set1, the glenoid G is prepared. Thus, a pin 6 is introduced into theglenoid so as to extend lengthwise in an implantation axis Z6 that isdetermined by the surgeon. This implantation axis Z6 will form, whenusing the set 1, the proximodistal direction that has been consideredabove to describe the set 1. In addition to place the pin 6, the surgeonprepares the glenoid G also by drilling a hole H through the subchondralbone layer G_(SUB) of the glenoid G: as shown in FIG. 31, the hole H isprepared so as to include both a circular central part H₁, that iscentered on the implantation axis Z6, and to longitudinal slots H₂ andH₃. The central part H₁ is dimensioned to be complementary to the outerface 14 of the body 11 of the anchorage member 10. Each of these slotsH₂ and H₃ extends lengthwise radially to the implantation axis and fromthe central part H₁, these slots H₂ and H₃ being diametrically opposedto each other with respect to the implantation axis Z6. In practice, thelongitudinal direction of the slots H₂ and H₃ can be substantiallyvertical with respect to the glenoid, as shown in FIG. 31. On itsproximal side, the hole H emerges outside the glenoid G whereas on itsdistal side, the hole H opens on spongious bone G_(SPO) (FIGS. 34 and35) of the glenoid G.

Once the hole H is prepared and while keeping in place the pin 6, theanchorage member 10 is fitted around the pin 6, by substantiallyaligning the implantation axis Z6 and the axis Z11, as shown in FIG. 31.The anchorage member 10 is then distally translated until the distal end11B of the body 11 comes into contact with the subchondral bone layerG_(SUB). If necessary, as shown in FIG. 32, the angular position of theanchor member around the axis Z11 is adjusted so that the distal ends15.1B and 15.2B of the portions of helix 15.1 and 15.2 axially faces thelongitudinal slots H₂ and H₃. At this stage, the body 11 of theanchorage member 10 is arranged above the subchondral bone layerG_(SUB). The anchorage member 10 is then driven in rotation around theaxis Z11: each of the portions of helix 15.1 and 15.2 entirely passthrough the subchondral bone layer G_(SUB) via the corresponding slotH₂, H₃. In the same time, the body 11 entirely passes through thesubchondral bone layer via the central part H₁ of the hole. Indeed,thanks to the lead and the winding of the portions of helix 15.1 and15.2, rotating the anchorage member 10 drives these portions of helix15.1 and 15.2 from above to below the subchondral bone layer G_(SUB) andthe anchorage member 10 reaches the implantation position shown in theFIGS. 33 to 35. In this implantation position, the proximal ends 15.1Aand 15.2A of the portions of helix 15.1 and 15.2 engage underside of thesubchondral bone layer G_(SUB), as shown by FIG. 34, whereas the rest ofthese portions of helix enters spongious bone G_(SPO) of the glenoid G,as shown by FIG. 35. Thus, the thread 15 of the anchorage member 10 hasbeen entirely passed through the subchondral bone layer G_(SUB), fromabove to below this subchondral bone layer: in the implantation positionof the anchorage member 10, the proximal end of the thread, which isformed by the proximal ends 15.1A and 15.2A of the portions of helix15.1 and 15.2 in the embodiment shown in the figures, engages undersideof the subchondral bone layer G_(SUB) and is efficiently retained inplace thereby, since this subchondral bone layer has been preserved allaround the hole H except at the slots H₂ and H₃ previously drilledduring preparation of the glenoid G. In some embodiments as the oneshown in the FIGS. 33 to 35, the implantation of the anchorage member 10can be thus performed without using cement while benefiting from goodmechanical strength.

Referring now to the FIGS. 36 and 37, the anchorage member 10, as in itsimplantation position of the FIGS. 33 to 35, is completed with othercomponents of the set 1 in order to obtain an anatomic glenoid implant.

FIG. 36 shows that the bone fastening screw 20 is first added to theanchorage member 10, by aligning its axis Z20 with the axis Z11 of thebody 11 and by distally introducing first the rod 22 then the head 21within the inner bore 12 of the body 11. This introduction of the bonefastening screw 20 is performed so that its rod 22 is progressivelyscrewed into cortical bone G_(COR) of the glenoid G, until its head 21is completely screwed into the threaded hole 19 of the inner bore 12.

FIG. 37 shows that the first insert 50 is then added to the anchoragemember 10, by aligning the central axis Z50 of the insert 50 with theaxis Z11 of the body 11 and by distally introducing the central peg 52.1within the inner bore 12 of the body 11. This introduction of thecentral peg 52.1 is performed so that the coupling feature 52 is fixedlyengaged with the first feature 16 of the body 11, especially by fittingalong the axis Z11, as shown by the FIG. 37. In practice, the insert 50can be assembled by being distally impacted. More generally, couplingthe anchorage member 10 with the first insert 50 by fitting along theaxis Z11 is particularly convenient because the insert 50 is not acomponent of revolution, which prevents or makes it very complicated anyscrewing of this insert into the anchoring member already implanted onthe glenoid G.

Besides, as shown by FIG. 37, coupling of the first insert 50 with theanchorage member 10 leads to axially introduce the lateral pegs 53respectively into the slots H₂ and H₃ of the hole H. The slots H₂ and H₃are thus partly plugged by the lateral pegs 53, which improves bothstability of the assembly of the anchor member 10 and the insert 50 andhealing of the glenoid G.

When the insert 50 is assembled with the anchorage member 10, the distalface 50B of the insert 50 is in direct contact with topside of thesubchondral bone layer G_(SUB), as shown by the FIG. 37. This contactcan have two interests. Bone colonization of the distal face 50B of theinsert 50 can therefore be made possible. And the stresses, which areapplied on the insert 50 in use and which have a distal component, aretransmitted to the glenoid G at least partly by pressing the distal face50B of the insert 50 directly against the subchondral bone layerG_(SUB), and not by the anchorage member. The risk of disassemblybetween the anchorage member and the insert 50 is thus limited.

According to a not shown variant, the second insert 60 is assembled withthe anchorage member 10 instead of the first insert 50. In that case,the glenoid G requires additional preparation consisting of drillingfree holes in the glenoid so that each of them receives one of thelateral pegs 63 of the insert 60.

According to a not shown variant, the bone fastening screw 20 is notadded, which means that the step illustrated by FIG. 36 is omitted.

According to a not shown variant, the spacer 30 and the bone graft 40can also be added to the anchorage member 10 before assembling one ofthe inserts 50 and 60 with the anchorage member 10. How adding thespacer 30 and the bone graft 40 to the anchorage member will beexplained in detail thereafter.

Whatever the insert selected from the first insert 50 and the secondinsert 60, the assembly of the anchorage member 10 with the insert, withor without the bone fastening screw 20, and with or without the spacer30 and the bone graft 40, corresponds to an anatomic glenoid implant.

Referring now to the FIGS. 38 to 42, the anchorage member 10, as in itsimplantation position of the FIGS. 33 to 35, is completed with othercomponents of the set 1 in order to obtain a reversed glenoid implant.

FIG. 38 shows that the spacer 30 is added to the anchorage member 10, bybeing arranged at the proximal end 11A of the body 11 and by aligningits axis Z31 with the axis Z11 of the body 11. The spacer 30 is distallyurged against the body 11 so as to engage its attaching feature 33 withthe attaching feature 18 of the body 11, as shown in FIG. 38.

FIG. 39 shows that the bone graft 40 is then added to the anchoragemember 10 and the spacer 30, by aligning its axis Z41 with the axis Z11of the body 11 and by surrounding the spacer 30 with the bone graft 40.

FIG. 40 shows that the second baseplate 100 is added to the anchoragemember 10, the spacer 30 and the bone graft 40, by aligning its axisZ101 with the axis Z11 of the body 11 and by arranging the baseplate 100against the proximal end face 40A of the bone graft 40.

FIG. 41 shows that the second coupling screw 80 is then added to theanchorage member 10, the spacer 30, the bone graft 40 and the baseplate100, by aligning its axis Z101 with the axis Z11 of the body 11 and bydistally introducing the rod 82 then the head 81 within the central bore102 of the baseplate 100. This introduction of the coupling screw 80 isperformed so that its rod 72 is progressively screwed into the secondfeature 17 of the body, especially the threaded hole 17.1 thereof, untilthe head 71 is supported against the bearing surface 102.1 of thebaseplate 100, as shown in FIG. 41. Moreover, two bone securing screws 7and 8 are respectively introduced within the lateral through holes 104of the baseplate 100 so as to be secured into the bone graft 40 and theglenoid G, as shown by FIG. 41.

FIG. 42 shows that the first glenosphere 110 is then added to theanchorage member 10, the spacer 30, the bone graft 40, the baseplate 100and the coupling screw 80, by aligning its connection axis Z113 with theaxis Z11 of the body 11 and by arranging the glenosphere 110 at theproximal face 101A of the baseplate 100. The taper connection betweenthe baseplate 100 and the glenosphere 110 is then carried out byengaging the male part 103 into the female part 113, as shown by FIG.42.

According to another not shown variant, the second glenosphere 120 isadded instead of the first glenosphere 110.

According to a not shown variant, the spacer 30 and the bone graft 40are not added to the anchorage member, which means that the stepsillustrated by the FIGS. 38 and 39 are omitted. In that case, the distalface 101B of the baseplate 100 is put in contact directly with theglenoid G. Also in that case, the first coupling screw 70 is usedinstead of the second coupling screw 80.

According to another not shown variant, the first baseplate 90 isassembled with the anchorage member 10, instead of the second baseplate100. Using the first baseplate 90 can be preferred when the bone graft40 is not used, so that the convex distal face 91B of the body 91 of thebaseplate 90 matches the glenoid G, or when the proximal end face 40A ofthe bone graft is concave shaped.

According to another not shown variant, the taper connection between thebaseplate 90, 100 and the glenosphere 110, 120 may be reversed. In thatcase, a male part of this taper connection is provided on theglenosphere and a female part of the taper connection is provided on thebaseplate.

Whatever the baseplate selected from the baseplate 90 and 100, whateverthe glenosphere selected from the glenospheres 110 and 120, and whateverthe coupling screw selected from the coupling screws 70 and 80 dependingon whether the spacer 30 and the bone graft 40 are used, the assembly ofthe anchorage member 10 with the baseplate, the glenosphere and thecoupling screw and with or without the spacer 30 and the bone graft 40corresponds to a reversed glenoid implant.

Based on the foregoing, it will be understood that while the anchoragemember 10 is already implanted, this anchorage member can be used aswell in the anatomic glenoid implant than in the reversed glenoidimplant, thanks to its first feature 16 and second feature 17 allowingthe body 11 to be coupled indifferently with one or with the other ofthe anatomic articulating member AAM and the reversed articulatingmember RAM. Choosing to implant the anatomic glenoid implant or thereversed glenoid implant can thus be delayed until surgery, after havingimplanted the anchorage member. It makes also possible to easily converta previously implanted anatomic glenoid implant into a reversed glenoidimplant while keeping the anchorage member.

In some not shown embodiments, the spacer can be integral with the bodyof the anchorage member when it is certain that the bone graft will beused in the glenoid implant to be obtained from the set.

In some not shown embodiments, a part, especially the male part, of thetaper connection by which the glenosphere is fixedly mounted on thebaseplate, can be integral with the body of the anchorage member. Inthat case, the use of the set is limited to exclusively obtain areversed glenoid implant and coupling the anchorage member with thebaseplate by an added coupling screw is not necessary. Therefore, anyinsert as the inserts 50 and 60 and any coupling screw as the screws 70and 80 can be omitted in the corresponding set.

1. Set for a glenoid implant, comprising: an anatomic articulatingmember, having a concave articulating surface intended to articulatewith a complementary humeral implant and having an anatomic couplingfeature, a reversed articulating member, having a convex articulatingsurface intended to articulate with a complementary humeral implant andhaving a reversed coupling feature that is shaped differently from theanatomic coupling feature, and an anchorage member intended to beanchored in a human glenoid, the anchorage member including a body whichdefines a proximodistal axis and has an inner bore extending along theproximodistal axis, the body being provided within the inner bore withboth: an inner first feature that is designed to cooperate with theanatomic coupling feature when the anatomic coupling feature isintroduced within the inner bore, so as to fixedly couple the anchoragemember with the anatomic articulating member, and an inner secondfeature that is designed to cooperate with the reversed coupling featurewhen the reversed coupling feature is introduced within the inner bore,so as to fixedly couple the anchorage member with the reversedarticulating member, the first feature and the second feature beingdistinct from each other, wherein the body is operable to be axiallyintroduced into the glenoid before being coupled indifferently with oneor the other of the anatomic and reversed articulating members.
 2. Setaccording to claim 1, wherein the first feature and the second featureare located at respective axial levels of the body that are differentfrom each other.
 3. Set according to claim 1, wherein the anatomiccoupling feature and the first feature cooperate with each other byfitting along the proximodistal axis.
 4. Set according to claim 3,wherein the anatomic coupling feature and the first feature are fittedtogether by snap fit along the proximodistal axis.
 5. Set according toclaim 4, wherein the first feature comprises a corrugated hole that iscentered on the proximodistal axis, and wherein the anatomic couplingfeature comprises a peg that is integral with an insert of the anatomicarticulating member and that is shaped to be axially received and to bewedged in the corrugated hole.
 6. Set according to claim 1, wherein thereversed coupling feature and the second feature cooperate with eachother by a screw connection.
 7. Set according to claim 6, wherein thesecond feature comprises a threaded hole that is centered on theproximodistal axis, and wherein the reversed coupling feature comprisesa coupling screw including: a head that is axially engaged with abaseplate of the reversed articulating member, and a rod that isthreaded to be screwed into the threaded hole.
 8. Set according to claim1, wherein the anatomic articulated member comprises an insert having aproximal face, on which is formed the concave articulating surface, anda distal face, from which at least a part of the anatomical couplingfeature protrudes.
 9. Set according to claim 1, wherein the reversedarticulating member comprises a glenosphere, on which is formed theconvex articulating surface, and a baseplate having a proximal face, onwhich the glenosphere is fixedly mounted, and a distal face from whichat least a part of the reversed coupling feature protrudes.
 10. Setaccording to claim 9, wherein the glenosphere is fixedly mounted on thebaseplate by a taper connection that is centered on the proximodistalaxis.
 11. Set according to claim 9, wherein the glenosphere defines acentral axis which is both parallel to the proximodistal axis and offsetfrom the proximodistal axis when the reversed articulating member iscoupled with the anchorage member.
 12. Set according to claim 1, whereinthe set further comprises: a spacer which is operable to be axiallyinterposed between the body and one or the other of the anatomicarticulating member and the reversed articulating member when theanchorage member is coupled indifferently with one or the other of theanatomic and reversed articulating members, and a bone graft which isconformed to surround the spacer and to be arranged axially between theglenoid and one or the other of the anatomic articulating member and thereversed articulating member.
 13. Set according to claim 1, wherein thebody is provided with an outer thread which is designed, when the bodyis driven in rotation around the proximodistal axis so as to beintroduced into the glenoid, to pass through a subchondral bone layer ofthe glenoid by entirely passing from above to below the subchondral bonelayer so that a proximal end of the thread engages an underside of thesubchondral bone layer and the rest of the thread enters spongious boneof the glenoid.
 14. Set according to claim 1, wherein the body isprovided with an outer thread which is designed, when the body is drivenin rotation around the proximodistal axis so as to be introduced intothe glenoid, to pass through a subchondral bone layer of the glenoid,the outer thread including at least one portion of helix which has alead between twelve and eighteen millimeters and wraps around the bodyover less than one turn and more than half of one turn.
 15. Setaccording to claim 1, wherein the set further comprises a bone fasteningscrew intended to be screwed into cortical bone of the glenoid, the bonefastening screw being operable to be axially passed through the body sothat a threaded rod of the bone fastening screw protrudes axially fromthe body so as to be screwed into cortical bone of the glenoid while athreaded head of the bone fastening screw is screwed in a complementarythreaded distal hole of the body.
 16. A glenoid implant, comprising: anarticulating member intended to articulate with a humeral implant; ananchorage member intended to be anchored in a human glenoid, theanchorage member including a body which defines a proximodistal axis andwhich is operable to be axially introduced into the glenoid before beingfixedly coupled with the articulating member; a spacer which is operableto be axially interposed between the body and the articulating memberwhen the body and the articulating member are coupled to each other; anda bone graft which is conformed to surround the spacer and to bearranged axially between the glenoid and the articulating member. 17.Glenoid implant according to claim 16, wherein the spacer extends as acoaxial extension of the body.
 18. A glenoid implant, comprising: anarticulating member intended to articulate with a humeral implant, andan anchorage member intended to be anchored in a human glenoid, theanchorage member including a body which defines a proximodistal axis andwhich is operable to be axially introduced into the glenoid before beingfixedly coupled with the articulating member, the body being providedwith an outer thread which is designed, when the body is driven inrotation around the proximodistal axis so as to be introduced into theglenoid, to pass through a subchondral bone layer of the glenoid byentirely passing from above to below the subchondral bone layer so thata proximal end of the thread engages underside of the subchondral bonelayer and the rest of the thread enters spongious bone of the glenoid.19. The glenoid implant according to claim 18, wherein the threadincludes at least one portion of helix, which has a proximal end formingthe proximal end of the thread and which is designed to entirely passthrough the subchondral bone layer via a longitudinal slot of thesubchondral bone layer when the body is driven in rotation around theproximodistal axis so as to be introduced into the glenoid. In someembodiments, the at least one portion of helix has a lead between twelveand eighteen millimeters and wraps around the body over less than oneturn and more than half of one turn.
 20. The glenoid implant accordingto claim 19, wherein the at least one portion of helix has a width whichgradually decreases from its proximal end to its distal end.